3. The Finnish Experience

Question 1

What % of global causes of all deaths is CVD?

Answer 1

31%

Question 2

What are health statistics in China?

Answer 2

43% mortality from CVD

2% from diabetes

Question 3

What are health statistics in UK?

Answer 3

25% mortality from CVD

1% from diabetes

Question 4

What are health statistics in Russian Federation?

Answer 4

55% mortality from CVD

1% from diabetes

Question 5

Where is the prevalence of raised blood cholesterol highest?

Answer 5

North East Europe, spain and Portugal is lower

Question 6

What happens to the prevalence of CVD in Americans under age and gender?

Answer 6

Increases with age for both genders
Males higher than females 20-44 years
Males lower than females after

Question 7

What did the Ni-Hon-San Study show?

Answer 7

Japanese living in Japan to have the lowest cholesterol levels and lowest rates of CHD, those living in Hawaii to have intermediate rates for both, and those living in San Francisco to have the highest cholesterol levels and CHD incidence

Question 8

When was the concept of risk factors first conceived?

Answer 8

in the Framingham Heart Study, involved gaining understanding of factors predisposing to occurrence of CVD

Question 9

What was the Framingham heart study?

Answer 9

first large-scale epidemiological study, begun in 1948 among 5,209 men and women.

Question 10

What did the Framingham study first demonstrate?

Answer 10

epidemiological relationship between cigarette smoking, blood pressure, and cholesterol levels to incidence of CHD

Question 11

What are clinical manifestations of atherosclerosis?

Answer 11

Coronary heart disease
(Stable angina, acute myocardial infarction, sudden death, unstable angina),
Cerebrovascular disease
(Stroke, transient ischemic attack (TIA)),
Peripheral arterial disease
(Intermittent cramp, pain in legs on walking, increased risk of death from heart attack and stroke)

Question 12

What are the most common risk factors for heart disease?

Answer 12

High LDL (‘bad’) cholesterol
Smoking
Low HDL (‘good’) cholesterol
High blood pressure
Lack of physical activity
Diabetes (automatic high risk)
Obesity
Age
Family History

Question 13

What is a blood pressure misconception?

Answer 13

Blood pressure originally thought to be normal to rise with age to ensure adequate perfusion as arteries narrowed, and elevated diastolic blood pressure felt to cause all problems

Question 14

What is a physical activity misconception?

Answer 14

Before epidemiological studies, physical activity was thought to be dangerous to CHD candidates

Question 15

Why is cholesterol important?

Answer 15

Fatty substance made in liver and a dietary component

Used to insulate nerve cells, to form cell membranes, and a steroid hormone precursor

Too much cholesterol leads to a build up in the arteries – increases risk of heart attack and stroke

Question 16

REMEMBER CHOLESTEROL METABOLISM

Answer 16

REMEMBER CHOLESTEROL METABOLISM

Question 17

How does transporting cholesterol work?

Answer 17

Cholesterol is highly water-insoluble and will not be soluble in blood

Lipoproteins (LDL, HDL) carry cholesterol throughout the body

HDL removes cholesterol from the arteries and carries it to the liver where it is broken down and excreted

LDL has a tendency to build up on the walls of arteries – this is harmful and increases the risk of heart disease/stroke

Question 18

What should total cholesterol be?

Answer 18

Cholesterol: total should be less than 200 mg/dl blood

Question 19

What should LDL be?

Answer 19

LDL: below 120 mg/dl – but below 100 is optimal. If known heart disease, levels should be 70-100 (higher the risk, the lower the LDL should be)

Question 20

What should HDL be?

Answer 20

HDL: over 40 mg/dl but ideally over 60 mg/dl as heart disease risk is significantly lowered

Question 21

What does a 1% drop in blood cholesterol translate into?

Answer 21

2% drop in risk for heart disease

Question 22

What are four facts about triglycerides?

Answer 22

The form of fat found in food and in body fat

Fat is transported in blood as triglycerides

Major energy source

High triglyceride levels may increase the risk for heart disease

Question 23

What is normal/high for triglycerides?

Answer 23

For triglycerides, less than 150 mg/dl is normal

150 to 500 mg/dl is considered high

Over 500 mg/dl is very high

Question 24

What is the general formation of atherosclerotic plaques?

Answer 24

Normal to fatty streak (with foam cells) to lipid rich plaque (fibrous cap and lipid core) to thrombus

Question 25

What is the first step of Atherosclerosis pathogenensis?

Answer 25

Initiation of the injury – reversible; LDL reaches the intima of arterial walls and gets oxydized. Monocytes migrate and differntiate to macrophages. Cholesteryl esters accumulate in macrophages → Foam cells

Question 26

What is the second step of Atherosclerosis pathogenensis?

Answer 26

Progression of injury – Foam cells burst releasing cytokines and growth factors → smooth muscle cells migrate and secrete collagen and ECM; the platelets form the fibrous cap“

Question 27

What is the third step of Atherosclerosis pathogenensis?

Answer 27

Rupture of plaque – Foam cells go apoptotic, release of matrixmetaloproteases (MMPs), degradation of the matrix and distabilzation of fibrous cap → →clotting, thrombosis, heart attack

Question 28

What is the healthy heart diet? Fibre

Answer 28

Fibre:
Lowers blood cholesterol and LDL
Provides satiety and can displace less beneficial components
Associated with other beneficial components and activities
Decreases risk for heart attack (29g fibre/day in men can result in a 40% decrease in heart attack risk)

Question 29

What is the healthy heart diet? Good fats

Answer 29

Primarily monounsaturated fats: olive, peanut, flaxseed

Primarily polyunsaturated fats: sunflower, soybean, corn

Omega-3 fats: fatty fish, flaxseed, walnuts

Question 30

What is the healthy heart diet? What we should limit

Answer 30

Limit foods high in saturated fat, trans fat and cholesterol:
Full fat dairy products
Fatty meats
Tropical oils (palm, coconut)
Margarine
Foods with hydrogenated oils (cakes, biscuits)
Fried foods

Question 31

What is the exercise recommendations?

Answer 31

Plays a role in increasing HDL cholesterol levels

Beneficial in lowering triglycerides

Should be done consistently

Question 32

What did Stanford 3-Community Study (1972-75) find?

Answer 32

mass media vs. no intervention in high-risk residents to result in 23% reduction in CHD risk score

Question 33

What did North Karelia (1972-) find?

Answer 33

showed public education campaign to reduce smoking, fat consumption, blood pressure, and cholesterol
Number of deaths from CHD fell by 82%
Benecol was a major product of the North Karelia project

Question 34

What did Stanford 5-City Project (1980-86) find?

Answer 34

showed reductions in smoking, cholesterol, BP, and CHD risk

Question 35

What did Minnesota Heart Health Program (1980-88) find?

Answer 35

showed some increases in physical activity and reductions in women smoking

Question 36

What did the Finnish study find?

Answer 36

• 1970s
– North Karelia had the highest death rate from heart disease in the world
– Diet rich in animal fats (rural economy)
– High cholesterol, high blood pressure

Question 37

What is the North Karelia study?

Answer 37

12 month study as part of a major primary prevention programme in Finland

Question 38

What is benecol?

Answer 38

Benecol is composed of plant stanol esters, which are hydrogenated forms of plant sterols. This type of margarine is synthetically produced as plant stanols exist only in small quantities in nature

Question 39

What is the active ingredient in benecol?

Answer 39

a Stanol ester